According to Jeffrey Shanton, chair, advocacy and legislative affairs committee, for NJAASC, proposed changes include the following:
- Creation of a new HOPD fee schedule, separate from ASCs. “NJAASC had commented that the original outpatient fee schedule had lumped ASCs, HOPDs and office-based practices together, which created problems,” Mr. Shanton says. “The creation of this new HOPD schedule will probably mean increased payment for HOPDs, a la the current CMS system, wherein ASCs are paid some 40 percent less than HOPDs. It is uncertain if it will include any additional codes.”
- 117 neurosurgical/spine codes will be removed from the physician portion of the fee schedule. “This does not mean they are deleted and cannot be performed,” Mr. Shanton says. “The neurosurgeons successfully lobbied DOBI for additional payment for these codes. Thus, they will not be subject to the fee schedule, but paid UCR.”
- Deletion of reference to the workers’ compensation managed care organizations. “This was another point raised by our comments — that use of workers’ compensation networks for PIP was wrong, as those networks were not sufficient in geographic coverage or scope, and not subject to oversight as an organized delivery system would be,” Mr. Shanton says.
He says DOBI did not address a number of items in its proposed revisions, including several issues regarding the arbitration process, which could affect ASCs, and the issue of codes not included on the PIP fee schedule. “If indeed some of the missing codes would now appear on the HOPD schedule, that would still not allow for their being performed in an ASC,” Mr. Shanton says. “DOBI has no regulatory or legal authority/ability to determine what procedures can or cannot be performed in an ASC.”
Finally, he says there is no mechanism in the current or proposed PIP regulations for adjudication of un-listed procedures. “If it is not on the fee schedule, you do not get paid for it as the facility, even if there is reimbursement listed for the physician,” Mr. Shanton says.
While Mr. Shanton says NJAASC was pleased to see some changes made, DOBI did not go far enough to address concerns expressed by the Association.
“While it is encouraging that DOBI decided to make substantive changes based on the comments received, the scope and content was disappointing to ASCs,” he says. “The continued exclusion of procedures currently performed and reimbursed in ASCs from the proposed fee schedule is disturbing. DOBI does not have the authority, is not the arbiter, of what can and cannot be performed in an ASC. We will continue to work closely with the governor’s office, key legislators and DOBI to rectify this troubling situation.”
According to a DOBI news release (pdf), the proposed changes will be released on Feb. 21, which will trigger a 60-day comment period.
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